Men’s Health Update: Prostate Cancer Signs, Symptoms & Screenings

Adler Howard Adler, MD, FACS
Director, Prostate Care Program
Stony Brook Medicine

Stony Brook Medicine is dedicated to heightening awareness of preventable health problems and encouraging early detection and treatment of disease specific to men. Because prostate cancer is the number-one solid organ cancer in the country yet has an extremely high survival rate — upwards of 85 to 90 percent — Howard L. Adler, MD, FACS, Director of the Prostate Care Program, encourages men to educate themselves. Here’s what every man should know.

What is prostate cancer and what are the symptoms?
The prostate is a walnut-sized gland located below the bladder and in front of the rectum in men. Nearly all forms of prostate cancer start with small changes in the size and shape of the prostate gland cells. These cells can grow uncontrollably, creating tumors. In most cases, these tumors grow very slowly; however, in a small percentage of cases, they can be more aggressive.

Unfortunately, prostate cancer in the early, slow-growing stages is almost always symptom-free. Bone pain or blood in the urine may indicate an advanced stage of prostate cancer. But the majority of men have no signs or symptoms. That’s why it is so important to be screened regularly.

What do prostate screenings entail?
There are two components. One is the PSA blood test, which measures the level of Prostate Specific Antigen in the blood. Elevated levels may indicate the presence of cancer.

The second component is the digital rectal exam performed by a urologist. While this is the test that many men are apprehensive about, for the majority it is a quick and painless procedure, lasting just a few seconds. During this exam, the urologist checks for irregularities, asymmetry and hard areas in the prostate. It is important to do both exams because it is possible for a person to have low PSA levels yet still have prostate cancer. Combined, the screenings are highly effective in early detection — key because when caught early, prostate cancer is highly treatable.

Who should get screened?
The American Urological Association recently changed its guidelines regarding the recommendations for prostate cancer screening. Men should speak with their physician to determine if screening is appropriate for them.  Recently, the United States Preventive Services Task Force recommended against routine PSA screening. However, it is difficult for a patient to make an informed decision about his prostate health unless he knows his PSA level.

What are the risk factors for prostate cancer?
The risk factors include:

  • Race African Americans have higher rates than the rest of the population.
  • Age Risk increases with age.
  • Family history If your father, brother or grandfather had prostate cancer, your risk may be higher.
  • Diet The high-fat, high-calorie Western diet is a factor.
  • Agent Orange exposure Past exposure to this chemical brings elevated risk.
  • Viruses and infections Researchers believe there may be a link between certain illnesses and prostate cancer.

What are the treatment options?
Perhaps the most important thing a man can do upon diagnosis is to find a urologist who he trusts. A good urologist is not only up-to-date on the available options, but also can help a patient choose the most appropriate course for his individual situation, taking into account his age, general health and the stage of the cancer. For example, one patient may not need immediate intervention; it may be smarter to take what doctors call a “watchful waiting” approach. Another may benefit from a clinical trial — something that a urologist can connect him with. 

What distinguishes Stony Brook’s approach?
In addition to access to state-of the-art technology and procedures (including laparoscopy, robotics, radiation therapy, cryosurgery and clinical trials), Stony Brook Medicine offers a multidisciplinary approach. At monthly genitourinary tumor board meetings, newly diagnosed cases are discussed by experts from the urology, medical oncology, radiation oncology, pathology and radiology departments to ensure that patients receive the most comprehensive care possible.